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312 North Main Street
Bishop, CA 93514
www.sierramtnguides.com

Participation Agreement, Release, and
Acknowledgement of Risk 

In consideration of the services of the Sierra Mountain Guides, Inc. their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereafter collectively referred to as "SMG"), I hereby agree to release, indemnify, and discharge SMG, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows;

1. I acknowledge that my participation in alpine mountaineering, rock and ice climbing, and ski mountaineering entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. 

The risks include, among other things; the hazards of walking on uneven terrain and slips and falls, being struck by rock fall, ice-fall, or other objects dislodged or thrown from above, the use of climbing ropes and equipment, the forces of nature, including lightning, weather changes, and avalanche, the risks of falling off the rock, mountain, or into a crevasse, the risks of exposure to insect bites, the risk of altitude and cold including hypothermia, frostbite, acute mountain sickness, cerebral and pulmonary edema, exposure to airborne illness and/or infectious disease (including COVID19), my own physical condition, and the physical exertion associated with this activity. 

Furthermore; SMG guides have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, or other environmental conditions. They may give inadequate warnings or instructions, and the equipment being used might malfunction. 

2.) I expressly agree and promise to accept and assume all the risks existing in this activity. My participation in this activity is purely voluntary and I elect to participate in spite of the risks.

3.) I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless SMG from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of SMG's equipment or facilities, including any such Claims which allege negligent acts or omission of SMG

4.) Should SMG or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify them and hold them harmless for all such fees and costs.

5.) I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

6.) In the event that I file a lawsuit against SMG, I agree to do so solely in the state of Nevada, and I further agree that the substantive law of that state shall apply in the action without regard to the conflict of law rules of that state. I agree that if any portions shall remain in full force and effect.

7.) I agree to abide by the COVID-19 Policy set forth by Sierra Mountain Guides and provide either proof of full COVID vaccination OR a current negative COVID-19 test within 48 hours of the start of my program.  Failure to comply with this policy will result in the cancelation of my program with no refund.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against SMG on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. 

TODAY'S DATE: January 22, 2022

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Parent or Guardian's Email Address

Email*

Confirm Email*
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Photographic Model Release

We often like to use pictures of participants on our trips on brochures, cards, our website, slide shows, magazines, and other media and advertising. Please indicate here if you agree that we can use photos of you from our trip in the manner.

Yes, I agree that you may use photos of me in the manner described.
Medical Questionnaire

Our guide programs take place in the mountains, often in remote locations where outside medical assistance is far away. For this reason, all SMG guides are certified as Wilderness First Responders or better. This form provides us with critical information to help guides and support staff handle any medical issues or emergencies that may arise in the field. It is important to complete this form thoroughly and honestly to the best of your ability. All information submitted on this form is kept in strict confidence by SMG guides and staff. We ask you to update this information with the office or your guide if anything changes between now and your program start date. Thank to you taking the time to help us provide you with the safest, most enjoyable, and most professional guided mountain experiences!Click to customize text

Recent Medical History
Are you, or have you been, sick within the past month?*
No
Yes
Do did you have symptoms* consistent with COVID-19? * Symptoms that may appear 2-14 days after exposure to the virus: Cough Shortness of breath or difficulty breathing Or at least two of the following: Fever Chills Repeated shaking with chills Muscle pain Headache Sore throat New loss of taste or smell*
No
Yes
To your knowledge, have you been in contact with anyone that may have been contagious with COVID-19, with or without symptoms, in the past month?*
No
Yes
Medical Questionnaire

Please describe your approximate level of fitness and ability using one of the choices above.

Type of Program
What type of program have you signed up for?

Please describe your prior experience related to the type of program you have signed up for.

What do you hope to achieve from this experience?

Emergency Contacts

This is the person we would call on your behalf in the event of an emergency.

How is this person related to you?


Emergency Contact Home Phone

Emergency Contact Cell Phone *

Emergency Contact Email *

Health Insurance Provider

Policy Number

Physician's Name

Physician's Phone Number

Do you have any food allergies?

No
Yes

If Yes, please elaborate

For trips where we provide food, please let us know your needs and preferences. We are happy to accommodate you the best that we can within the practical limitations of backcountry cuisine.

Medical History

Do you have, or have you had within the past 3 years, any of the following?

Altitude Illness?*
No
Yes

If Yes, please elaborate
Broken Bones?*
No
Yes

If Yes, please elaborate
Severe Sprains?*
No
Yes

If Yes, please elaborate
Shoulder or Neck Problem?*
No
Yes

If Yes, please elaborate
Back Problem?*
No
Yes

If Yes, please elaborate
Foot or Ankle Problem?*
No
Yes

If Yes, please elaborate
Leg or Knee Problem*
No
Yes

If Yes, please elaborate
Arm or Hand Problem?*
No
Yes

If Yes, please elaborate
Intestinal Problem?*
No
Yes

If Yes, please elaborate
Urinary Tract Problem?*
No
Yes

If Yes, please elaborate
Heat or Cold Intolerance?*
No
Yes

If Yes, please elaborate
Uncorrected Vision or Hearing Impairment?*
No
Yes

If Yes, please elaborate
Diagnosed Mental Illness?*
No
Yes

If Yes, please elaborate
Severe Anxiety or Depression?*
No
Yes

If Yes, please elaborate
High Blood Pressure?*
No
Yes

If Yes, please elaborate
Heart Disease?*
No
Yes

If Yes, please elaborate
Seizure Disorder?*
No
Yes

If Yes, please elaborate
Asthma?*
No
Yes

If Yes, please elaborate
Diabetes?*
No
Yes

If Yes, please elaborate
Chronic Headaches?*
No
Yes

If Yes, please elaborate
Shortness of Breath?*
No
Yes

If Yes, please elaborate
Chest Pain?*
No
Yes

If Yes, please elaborate
Hospitalization in the Past Year?*
No
Yes

If Yes, please elaborate
Are You a Woman AND Currently Pregnant?*
No
Yes

If Yes, please elaborate
Are you currently taking any medications?*
No
Yes

If Yes, please elaborate
Are you allergic to any insect bites, medications, or any other known allergen?*
No
Yes

If Yes, please elaborate
Do you have any other physical or mental condition or limitation that could affect your participation or the experience of others on this program?*
No
Yes

All of the information given to Sierra Mountain Guides on this form is complete and accurate to the best of my knowledge.


Initials here or initials of parent/guardian if participant is under age 18 *
Proof of COVID-19 vaccination or COVID-19 Test
  
Click to customize text box label
Valid file types: JPG, GIF, PNG, and PDF
Rental Equipment

Do you need rental equipment? If yes, what do you need and what size (if applicable).
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Home Phone:

Cell Phone: *

Trip or Course Description: *

Start Date: *

End Date: *

Height: *

Weight: *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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